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Creating Your Path— Focusing on Your Future Retiree Health Care. BB&T | August 2014. Content. New Delivery Model for Medicare-Eligible Retirees. Overview of Retiree Benefit. For all BB&T retirees and spouses of retirees 65 or older:

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Presentation Transcript
  • New Delivery Model for Medicare-Eligible Retirees
overview of retiree benefit
Overview of Retiree Benefit
  • For all BB&T retirees and spouses of retirees 65 or older:
    • If you are over age 65 and your spouse is under age 65, you may elect to cover your spouse through the BB&T Retiree medical coverage (Select or Consumer options ) through BCBS NC. BB&T will draft your account for the pre-65 coverage
    • If you elect the BB&T Retiree Life Insurance, BB&T will draft your account for the premium
    • You may have 2 different enrollment periods:
      • BB&T open enrollment for pre-65 Health care and for Life Insurance in November
    • If you and your spouse are both 65 or older, you will each make an election with Aon Retiree Health Exchange for your Medicare Supplement coverage and will be billed separately for coverage
introducing aon retiree health exchange
Introducing Aon Retiree Health Exchange
  • An independent insurance exchange
  • Offers Medicare insurance plans from quality carriers
    • Financially stable
    • “Staying power” in the marketplace
    • Name brands such as AARP, Blue Cross and Blue Shield, Humana, and United Healthcare
  • Broad range of products to meet individual needs
  • Employs licensed and certified benefit advisors
    • Are salaried; no incentive to steer individuals to specific carriers and/or plans for you!
    • Benefit advisors are licensed, certified, and experienced in Medicare related insurance.
    • Will assist you through the entire process and will remain your advisor ongoing
why aon retiree health exchange
Why Aon Retiree Health Exchange?
  • Aon Retiree Health Exchange is one of the nation’s most trusted advisors in navigating Medicare—it’s advice you can count on
  • We have a reputation for providing expert, independent assistance to Medicare recipients who expect and deserve high-quality health insurance at an affordable price
  • Aon Retiree Health Exchange presents complex health insurance information in an objective manner via its Internet site and trained and licensed insurance professionals
  • The Benefit Advisors are located in Lincolnshire, Illinois, Charlotte, North Carolina, Orlando, Florida, The Woodlands, Texas and Winston-Salem, North Carolina
enrollment process for medicare eligible retirees
Enrollment Process for Medicare-Eligible Retirees
  • Getting Started
    • Confirm your appointment
    • Read materials in the education kit or online
    • Collect the following:
      • Medicare card
      • List of doctors
      • List of medications
  • Learn/Compare/Enroll
    • Talk with your benefit advisor
    • Complete necessary paperwork
    • Enroll over the phone
2014 medicare part a inpatient hospital care
2014 Medicare Part A (Inpatient Hospital Care)

What Is Covered

What You Pay

Enrollment in Medicare:

Part A is automatic for most people who have worked 40 quarters in their lifetime

Deductible: $1,216 per benefit period

A benefit period starts the day you leave the hospital and lasts 60 days

  • Part A covers part of the following services:
    • Inpatient hospital care
    • Inpatient care in a skilled nursing facility (not custodial or long-term care)
    • Hospice care services
    • Home health care services
    • Nursing home care
2014 medicare part b outpatient hospital and doctor care
2014 Medicare Part B (Outpatient Hospital and Doctor Care)

What Is Covered

What You Pay

Premium: $104.90

Social Security determines the premium amount based on the last 2 years of taxable income

Deductible: $147


Medicare pays 80%

Participant pays 20%

  • Outpatient care
    • Doctors’ visits
    • Outpatient hospital
    • Lab services
  • Preventive care
  • Emergency room visits
  • Mental health
  • Ambulance
  • Lab tests
current plan
Current Plan

Original Medicare

Part B

(covers doctors and

outpatient visits)

Part A


hospital stays)


Medicare Supplement Plan + Rx Drug Coverage (Optional)

medicare insurance plan options
Medicare Insurance Plan Options


Original Medicare

Part B

(covers doctors and

outpatient visits)

Part A


hospital stays)



Replace Original Medicare with

Medicare Advantage

Keep original Medicare and add:

Medicare Supplement Insurance


(covers some or all of the costs

not covered by Part A or B)

Part C

(combines Part A and B

and may include prescription drugs)

Offered by Private Companies


If Part C of your plan

does not include prescriptions, consider adding Part D.


Medicare Part D

Part D



Offered by Private Companies

Offered by Private Companies

medicare supplement medigap plans
Medicare Supplement (Medigap) plans

In the open market, there are options known as Medicare Supplements.

  • Medicare Supplements supplement the Medicare coverage you already have
    • Medicare remains your primary; your Supplement is your secondary
  • With Medicare Supplement plans, you can go to any doctor, any medical facility in the country as long as the doctor/medical facility accepts Medicare and the service is Medicare approved (similar to what you currently have)
  • Plans are all federally regulated
    • Plans come with a range of coverage—Plans A through N
      • Plan F has highest level of coverage
        • Covers your deductibles and out-of-pocket expenses left over by Medicare
    • Plans from company to company are the same—only difference is price
      • Prices vary by company, age, and service area
  • Current group supplement is similar to Medigap Plan F—except for Part B deductible

Medicare Supplement Chart

For illustrative purposes only.

guaranteed issue of coverage for medicare supplement medigap
Guaranteed Issue of Coverage for Medicare Supplement (Medigap)
  • “Guaranteed issue” means that during this special election enrollment period for retirees, you’re automatically accepted by the insurance plan without having to answer medical questions
    • You have guaranteed acceptance into any Medicare Supplement Plan, regardless of any pre­-existing health conditions
  • Enrolling in a Medicare Supplement Plan after this period, in most states, requires approval from the insurance company
  • This is a one-time chance for those age 65 and older
    • For those turning age 65 in the future, you have the same opportunity during your initial enrollment

2014 Medicare Part D Plans

(Prescription Drug Coverage)

Deductible $310

100% Paid by Participant

25% Paid by Participant

75% Paid by Plan

Initial Coverage Level $2,850 Limit

2.5% Paid by Plan


(50% Discount)

47.5% Paid

by Participant

The Donut Hole

Exit at $4,550


72% Paid by Participant

28% Paid

by Plan

15% Paid by Plan

80% by Medicare


Catastrophic Coverage

medicare advantage plans part c
Medicare Advantage Plans (Part C)
  • Obtain Medicare Parts A/B coverage through the Medicare Advantage Plan, not Original Medicare
  • Must pay:
    • Part B premium
    • Medicare Advantage Plan premium (if any)
    • Copays/coinsurance and deductibles, as applicable
  • Network-based:
  • Medicare Advantage Plans may offer extra coverage:
    • Vision, hearing, dental, health/wellness programs
  • Most plans include prescription drug coverage (Part D)
choosing a medical plan comparison
Choosing a Medical Plan Comparison

Supplement Plan (Medigap)

Medicare Advantage (Part C)

Low to no monthly premium/Pay as you go

Network based plans/HMOs, PPOs

Typically includes prescription drugs copays, coinsurance, and deductibles

No medical underwriting

  • Can be higher premium/low to no cost on the back end
  • Can go to any doctor or medical facility in the country that accepts Medicare
  • Does not include prescription drugs
  • Most plans include foreign travel emergency coverage
  • Guaranteed issue under certain circumstances
choosing a medical plan
Choosing a Medical Plan
  • Even if you and your spouse are both Medicare-eligible, your health needs may differ—each eligible person can choose a medical or prescription drug plan
  • You may change your Medicare Advantage and Part D plans every year during the Annual Enrollment Period (AEP) October 15–December 7
  • You may change your Medigapplan at any time during the year. However – you may be subject to underwriting
  • Initial Enrollment Period (IEP) – Newly Eligible
  • Tricare and VA coverage

Choices to Meet Retirees’ Needs

Telephonic Enrollment

  • Highly trained benefit advisor guides retirees through process
  • Retirees work with same benefit advisor throughout process (if desired)
  • Enrollments can be completed over the phone with telephonic signature
  • Preferred method—98%

Prefilled Paper

  • Many retirees prefer to review printed materials before making decision
  • Paper applications accepted via prepaid envelopes or fax


  • Detailed summary of benefits information
  • Comparison of current plan and alternate plans
  • Online plan application collection up to signature requirements
conveniently paying for your coverage
Conveniently Paying for Your Coverage
  • Two options:
    • Pay your health insurance premium by check each billing period


    • Have your premium automatically withdrawn from a checking or savings account
      • Most insurance providers allow automatic withdrawal as a convenient alternative to paper checks
retiree health reimbursement account hra highlights
Retiree Health Reimbursement Account (HRA) Highlights
  • Retiree HRA can only be used for reimbursement of eligible premiums for Medicare Supplement, Medicare Advantage, and/or Medicare Prescription Drug Plan, Medicare Part B and D coverage (including Part D penalties paid or surcharges)
    • Any additional premium expenses for the year would be paid by you
premium billing and hra reimbursement
Premium Billing and HRA Reimbursement



Pays insurance premiums directly to carrier

Reports premium payments to Aon Retiree Health Exchange

Aon Retiree Health Exchange

Reimburses retirees for premiums

premium billing and manual claim hra reimbursement
Premium Billing and Manual Claim HRA Reimbursement


Pays insurance premiums directly to carrier and completes manual claim form each month for eligible expense and submits to Aon Retiree Health Exchange/Your Spending Account™

Aon Retiree Health Exchange


Retiree receives premium increase from carrier and fills out a

manual claim form for premium increase and submits to Aon Retiree Health Exchange/Your Spending Account

Reimburses retirees for premiums

advocacy the solution
Advocacy—The Solution

Retirees Need Assistance

Advocacy Services

Pioneered service in 1999

200 clients

3.6 million participants

Advocates average 18 years of industry experience

  • Access to care and prescription drugs
  • Claim denials and incorrect payments
  • Billing disputes
  • Authorization and referrals
  • Medicare coordination
medicare advocacy examples
Medicare Advocacy Examples




Receiving unexpected bills from rheumatologist

  • Provider miscoded diagnosis and CPT code; as a result, charges were not eligible for Medicare reimbursement
  • Advocate worked with provider to correct and refile bill with Medicare
  • After bill was reprocessed, advocate communicated accurate liability to retiree

Erroneous CPT code

Incorrect Medicare claim denial

Medicare denied a claim, indicating Medicare was not the primary payer

  • Retiree did have additional coverage; however, Medicare was primary
  • Advocate facilitated refiling claim with Medicare, then forwarded EOBs to health plan for secondary payment

Access to wheelchair

Medicare denied a retiree’s request for a wheelchair

  • Medicare denied claim as not medically necessary
  • Advocate collected medical records and forwarded them to Medicare
  • Once approved, advocate made arrangements for home delivery of wheelchair
  • Visit
  • On the website, you can:
    • Confirm your appointment
    • Change you appointment
    • Add your prescriptions
    • Compare plans
    • Create a unique user ID


If you have questions:

Call Aon Retiree Health Exchange at +1.888.628.2393